Eddie Jones

Social and economic burden of walking and mobility problems in multiple sclerosis

BackgroundMultiple sclerosis (MS) is a chronic progressive neurological disease and the majority of patients will experience some degree of impaired mobility. We evaluated the prevalence, severity and burden of walking and mobility problems (WMPs) in 5 European countries.MethodsThis was a cross-sectional, patient record-based study involving 340 neurologists who completed detailed patient record forms (PRF) for patients (>18 years) attending their clinic with MS. Patients were also invited to complete a questionnaire (PSC). Information collected included demographics, disease characteristics, work productivity, quality of life (QoL; EuroQol-5D and Hamburg Quality of Life Questionnaire Multiple Sclerosis [HAQUAMS]) and mobility (subjective patient-reported and objectively measured using the timed 25 foot walk test [T25FW]). Relationships between WMPs and disease and other characteristics were examined using Chi square tests. Analysis of variance was used to examine relationships between mobility measures and work productivity.ResultsRecords were available for 3572 patients of whom 2171 also completed a PSC. WMPs were regarded as the most bothersome symptom by almost half of patients who responded (43%; 291/683). There was a clear, independent and strong directional relationship between severity of WMPs (subjective and objective) and healthcare resource utilisation. Patients with longer T25FW times (indicating greater walking impairment) were significantly more likely to require additional caregiver support (p < 0.0001), visit a variety of healthcare professionals including their primary care physicians (p = 0.0044) and require more long-term non-disease modifying drugs (p = 0.0001). A similar pattern was observed when subjective reporting of the severity of WMPs was considered. Work productivity was also markedly impacted by the presence of WMPs with fewer patients working full time and a reduction in weekly working hours as T25FW times and the subjective severity of WMPs increased.ConclusionsIn Europe, WMPs in MS represent a considerable personal and social burden both financially and in terms of quality of life. Interventions to improve mobility could have significant benefits for patients and society as a whole.

REAL WORLD ADMINISTRATION OF THE ALZHEIMER’S DISEASE ASSESSMENT SCALE-COGNITIVE

Background: The Alzheimer’s disease assessment scale-cognitive (ADAS-Cog) is the preferred efficacy measure in Alzheimer’s disease (AD) clinical trials but is rarely used in real-world practice ADAS-cog data generated in the real-world could be used to facilitate a better understanding of the clinical and economic meaningfulness of ADAS-cog changes observed during trials. The objective of this analysis was to estimate the frequency of ADAS-cog use in the real-world and describe the characteristics of administering physicians and their patients. Methods: Data were taken from the 2015/16 Adelphi RealWorld Dementia Disease Specific Programme, a cross-sectional survey of physicians, and their patients with cognitive impairment (CI) in the UK, France, Italy, Germany, Spain, Canada and the US. Physicians completed interviews about their clinical knowledge and practice setting and also completed record forms, containing patient demographics, clinical characteristics, diagnosis and tests/scales performed to aid diagnosis. Results: While 71% (n1⁄4534) of all physicians surveyed (n1⁄4757) were aware of the ADAS-Cog, only 40% (n1⁄4211) used the ADAS-Cog in clinical practice with varying levels of frequency: 9.5% very often, 22.4% often, 52.4% occasionally and 15.7% rarely. Physicians who administered the ADAS-Cog were more likely to be neurologists (48.8% vs. 37.6%, p1⁄40.0410), deliver care at memory clinics (50.5% vs. 25.5%, p<0.0001), or were currently involved in CI/dementia clinical trials (10.6% vs.

DETERIORATING COGNITION ASSOCIATED WITH HIGHER LEVELS OF INSTUTIONALIZATION IN JAPAN

PATIENT Work for pay, n (%) yes 138 (21.3) 65 (10.0) 91 (15.4) 83 (15.0) 58 (20.6) 33 (10.7) 60 (23.3) 23 (7.8) Reduced work due to health, n (%) 84 (16.5) 119 (20.6) 78 (15.8) 102 (21.7) 35 (15.8) 43 (15.8) 34 (17.3) 67 (24.8) Cut down hours due to AD, n (%) 5 (3.6) 9 (13.8) 5 (5.5) 6 (7.2) 2 (3.4) 3 (9.1) 1 (1.7) 5 (21.7) Re-entered work force to supplement income for loss due to declining cognition, n (%) 9 (6.5) 10 (15.4) 10 (11.0) 6 (7.2) 5 (8.6) 5 (15.2) 2 (3.3) 4 (17.4)

DETERIORATING MMSE SCORE ASSOCIATED WITH HIGHER LEVELS OF INSTUTIONALIZATION IN AUSTRALIA

Background:Although there is no cure for Alzheimer’s disease (AD), there are medications that ameliorate symptoms, some of which may occur prior to AD diagnosis. This retrospective cohort analysis aims to describe the potential healthcare cost implications of the timing of treatment initiation relative to AD diagnosis. Methods: Newly diagnosed AD patients were identified in the January 2010 – December 2016 Truven Health MarketScan Commercial and Medicare Supplemental Databases and stratified by payer type: commercial (50-64 years) and Medicare (65-100 years). Study patients were required to have continuous medical and pharmacy benefits enrollment for 36 months prior to, and 12 months following, the first AD diagnosis and no evidence of vascular dementia or other severe neuropsychiatric conditions during the preceding 36 months. Patients were categorized into four sub-cohorts based on the sequence of initial diagnosis and treatment: diagnosed but no treatment; concurrent diagnosis and treatment (within +/60 days), treatment first (treatment >60 days prior to diagnosis); diagnosis first (treatment >60 days after diagnosis). Total perpatient per-year all-cause healthcare costs were measured during the 36 months preceding and the 12 months following the first AD diagnosis. Results:A total of 2,372 treated and 944 untreated commercial patients, and 55,598 treated and 20,504 untreated Medicare patients were included in the analysis. Treatment first was the most common treatment sequence (Commercial: 49%; Medicare: 62%). Mean annual total healthcare costs are presented in figure 1. In both cohorts, treated patients who received concurrent treatment incurred the lowest costs during the 36 months preceding and the 12 months following the initial diagnosis. in the Medicare cohort, untreated patients followed by those who were diagnosed first (i.e. received treatment at least 60 days later) incurred the highest costs in the 12 months following diagnosis. In the commercial cohort, untreated patients followed by those who received treatment first incurred the highest costs both before and after treatment. Conclusions:These results demonstrate that initiating treatment at the time of initial diagnosis is associated with lower costs. Understanding the optimal timing of treatment initiation for clinical and cost outcomes is important for informing disease management strategies. P3-600 DETERIORATING MMSE SCORE ASSOCIATEDWITH HIGHER LEVELS OF INSTUTIONALIZATION IN AUSTRALIA Christopher M. Black, Eddie Jones, Rezaul Karim Khandker, Joseph Husbands, James Pike, Baishali M. Ambegaonkar, Michael Woodward, Merck&Co., Inc., Kenilworth, NJ, USA; Adelphi Real World, Macclesfield, United Kingdom; Austin Health, Melbourne, Australia. Contact e-mail: christopher. black2@merck.com

THE RACE TO DIAGNOSE: DISEASE SEVERITY AS A FACTOR OF ALZHEIMER’S DISEASE DIAGNOSIS

vs. 87.5 per 100 person-years). Number of planned admissions didn’t differ between the dementia subtypes, but DLB patients had more frequent of emergency admissions. We detected a strong association between DLB and hospitalization, which remained significant after adjusting for a wide range of confounders (hazard ratio: 1.59; 95% CI: 1.19-2.13). DLB patients had more admissions due to Parkinsonian symptoms, atrial fibrillation, constipation and delirium. Conclusions: DLB patients are more frequently admitted to hospital as emergencies and utilize inpatient care to a substantially higher degree than AD patients or the general older population. It would be important to assess whether hospitalizations can be reduced by identifying DLB earlier and providing more targeted outpatient care.

HOW ARE COGNITIVE IMPAIRMENT PATIENTS BEING DIAGNOSED

changes were observed in the same regions. Alzheimer disease pathology was also present in two members of the family. Conclusions: The E200K-129M haplotype is the most common form of fCJD while there are only five reported cases of E200K-129V haplotype in the literature. The presence of intraneuronal PrP immunopositive inclusions appears to be a consistent finding in subjects with the E200K mutation; however, their morphology needs to be further investigated with high resolution microscopy. Acknowledgements: P30AG010133; NIH P01 AG-14359, Charles S. Britton Fund and CDC UR8/CCU515004.

PATIENTS WITH ALZHEIMER’S DISEASE SUFFERED REDUCED QUALITY OF LIFE RELATIVE TO THE GENERAL POPULATION: RESULTS FROM A RECENT MULTINATIONAL CROSS-SECTIONAL SURVEY

Background:Previous studies have shown that individuals with poor social relationships have an increased risk for dementia. Dementia risk, however, can also be positively influenced by lifestyle factors such as high mental demands at work (in particular as the work environment affects a very long lifetime period). Thus, our objective was to investigate whether the cognitive functioning of socially isolated individuals may profit from high mental work demands. Methods: Analyses were based on n1⁄410,000 participants (aged 40-80 years) of the population-based German LIFE-Adult-Study. All participants underwent medical examinations and filled out standardized questionnaires. Cognitive functioning was assessed via the Verbal Fluency Test (VFT) and the Trail-Making Test (TMT). Social relationships were assessed via the Lubben Social Network Scale (LSNS-6). Results:The difference in cognitive functioning between high and low mental work demand conditions was larger in socially isolated individuals (VFT: 2.7 words, TMT-B: 26 seconds) compared to socially well integrated individuals (VFT: 2.1 words, TMT-B: 9 seconds). Multivariate regression analyses – adjusted for age, gender, and education – indicated that both mental work demands as well as social relationships are significantly associated with the level of cognitive functioning (p<0.001). Results also suggest interaction effects indicating a stronger impact of mental work demands on cognitive functioning in socially isolated individuals than in well integrated individuals. Conclusions: The findings imply that individuals with poor social relationships may particularly benefit from high mental work demands regarding their risk for dementia. The level of mental demands at work could therefore be an important target for tailored preventative approaches.

Relapse rates and work productivity among patients receiving disease modifying therapy (dmt) for multiple sclerosis (ms)

Background: Real-world studies suggest that natalizumab results in lower relapse rate versus other MS DMTs and improves work productivity. Objective: To compare relapse rates and work productivity using Work Productivity and Impairment (WPAI) questionnaire between MS patients treated by platform therapies, oral therapies or natalizumab. Methods: RRMS patients receiving natalizumab, platform or oral therapies for greater than 12 months were identified from the 2015 Adelphi MS Disease Specific Programme, a global (U.S., U.K., Spain, Italy, France and Germany) cross-sectional study that obtained patient consent/approval. Average treatment effects (ATEs) for 1113 patients (156 natalizumab, 711 platform, 246 oral) were estimated and adjusted utilizing a propensity score generated from age, gender, EDSS score at current treatment initiation, line-of-therapy, BMI, duration of current treatment, time sinceMS diagnosis, and number of comorbid conditions. Physician-reported relapses in the previous 12 months and work productivity were compared across treatments. Results: Relapse and WPAI data were available for 934 (122 natalizumab, 617 platform, 195 oral) and 222 (34 natalizumab, 137 platform, 51 oral) patients, respectively. Natalizumab patients suffered fewer relapses than platform (ATE =−0.21 vs. 0.48, p = 0.020) and oral therapy patients (ATE =−0.14 vs. 0.45, p = 0.075). Patients receiving natalizumab reported significantly less presenteeism, i.e., attending work while sick) than those receiving platform (ATE =−10.16% vs. 19.26%, p = 0.001) or oral therapies (ATE = −8.28% vs. 22.65%, p = 0.0018). Treatment was not associated with less overall work impairment. Conclusion: Treatment with natalizumab compared to platform or oral therapies was associated with a lower relapse rate and a significant reduction in impairment at work or presenteeism. Sponsored by Biogen.